The NIHR Policy Research Unit in Health and Social Care Workforce is a collaboration between researchers at King's College London, the University of Salford, the London School of Economics, and the Institute for Fiscal Studies (IFS).

George Stoye and Max Warner of the IFS last week published this examination of career progression of nurses and other staff groups within the NHS Agenda for Change pay framework in England.

Executive summary of the new report

In the 2023 pay negotiations between health unions and the Department of Health and Social Care, the government agreed to ‘work with employers and trade unions to improve opportunities for nursing career progression’ (NHS Employers, 2023). Career progression is an important determinant of job satisfaction and is often associated with an increase in skills, responsibility and autonomy of staff, as well as a movement towards roles that better suit staff. Getting the speed of progression, and the opportunities available to staff, right will be important for retention, recruitment and the productivity of the NHS workforce.

In this report, we examine the career progression of nurses and other staff groups within the NHS Agenda for Change (AfC) pay framework in England over the decade between 2012 and 2021. We document differences in progression across pay bands between staff groups and within groups of nurses to provide important context when considering how – and why – the career progression of nurses needs to be reformed.

To measure the career progression of NHS staff, we use the Electronic Staff Record (ESR), the monthly payroll of all staff directly employed by NHS organisations in England. We define career progression using AfC pay bands. Using pay bands to measure progression captures increases in pay and job responsibilities, but will not capture some other forms of career progression, such as movements between occupations on the same band. We study how quickly new starters in Band 5 (the point at which a newly qualified nurse joins the NHS) progress to Band 6 and beyond. For context, a new nurse starting their career in Band 5 had a basic full-time starting salary of £25,655 in 2021–22. Nurses in Band 6 had a starting basic full-time salary of £32,306 in the same year.

See also: co-author Max Warner's take on the findings in this thread on X.

This publication

Stoye, G. and Warner, M. (2024). Progression of nurses within the NHS. London: Institute for Fiscal Studies. Available at: https://ifs.org.uk/publications/progression-nurses-within-nhs

Acknowledgements and disclaimer

This research is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme, through the Policy Research Unit in Health and Social Care Workforce, PR-PRU-1217-21002. The authors also acknowledge financial support from the UK Economic and Social Research Council (ESRC) through the Centre for Microeconomic Analysis of Public Policy at IFS (ES/T014334/1). The views expressed are those of the authors and not necessarily those of the NIHR, the DHSC or the ESRC.

Also published by the IFS

The following report, again funded by the NIHR and the ESRC, was also published last week:

Stockton, I. and Stoye, G. (2024). Regional variation in earnings and the retention of NHS staff in Agenda for Change bands 1 to 4. London: Institute for Fiscal Studies. 

The IFS and the Unit's current programme of work, starting in 2024

IFS researchers are leading two of the Policy Research Unit's core projects: 

• NHS Careers Across Occupations (Elaine Kelly)
• The Social Care Workforce: Recruitment, Retention and Care User Health Outcomes (George Stoye)

Learn more about the Unit's programme of work.